Looking for clarification

[mediaworks]

Ok, here goes...In 1999/2000 was put on tetracyclene for acne.  Went on accutane for 20 weeks in '01 (was also put on propecia at same time so as not to lose hair caused by accutane).  Throughout accutane period all my monthly blood test came back normal.  Few months later went back to doc because I was very tired after I ate lunch on a normal basis. Did blood work everything was normal except slightly lowered platlet count (roughly 130-140). Told me no big deal I was tired due to the accutane & propecia. Went back to doc in 2003 for what I thought was candida (that's a whole other story) platelet count still between 130-140 - slightly lowered wbc around 3.8 I think.  Again, he told me no big deal. On to 2005. Went in for routine physical (new doc) when I turned 30. Blood tests came back low platelet again (also elevated IGA - I had my doc test for candida (which he really didn't know too much about)because there was some thought that due to the amount of antibiotics I had been on in the past I might have it as I stated above.  I'm still curious to know if I have a mild case of respiratory candida).  Anyway, apparently a serum test for IGA can be inconclusive.  So, had an ultrasound and found slightly enlarged spleen.  Had a ct scan, again, slightly enlarged spleen.  Everything else normal.  More blood work, now platelet count in good range 141 I think, but slightly lowered wbc 4.0.  My doc doesn't think anything major is going on here but wants me to see a hemotologist.  So,a month ago I go to hemo doc.  Checks me out does more blood work platelet slighlty lowered 133 and wbc now normal 4.3.  No other symptoms, other than mild itching (especailly when I think about it) that just started this week (I have very dry skin (from AZ) and the weather has been changing - maybe this is the cause?)  Doc does more additional blood work and xray of chest for lymph nodes.  Went back yesterday - Platelet still in same range 130-140, wbc 4.3, xray clear, felt spleen, lymph nodes - everything normal. Oh, also checked my Iga and came back slightly elevated - he was not concerned and asked me if I had had a yeast infection.  Also, I have allergies (nothing too debilitating - take claritan usually) and had a cold at time of last blood work.  As I said before I'm 30, I do drink - probably 1 time per week - but definitely more than 2 beers when I do drink - never really thought too much about it.  Since '99 have also had mild recurring prostatitis - haven't had in a while though - usually take one course antibiotics and advil or the like.  Also, when on the tetracyclene I still drank - I was 23/24 at the time that seemed more important back then.  So, my questions are a) can accutane cause enlarged spleen that doesn't shrink back after stopping b) should I be concerned about cirrhosis even though all my labs have been consistant since 2001 - almost five years and that's without changing anything in my life - diet, excersice, etc.  Any feedback would be great-thanks

[Kevin Pho, MD]

To answer your questions:
1) Here are the GI and hematologic side effects of accutane:
"Gastrointestinal: Weight loss, inflammatory bowel disease, regional ileitis, pancreatitis, bleeding and inflammation of the gums, colitis, nausea, nonspecific gastrointestinal symptoms

Hematologic: Anemia, thrombocytopenia, neutropenia, agranulocytosis, pyogenic granuloma"

Splenomegaly is not a specific side effect, however some of the hematologic reactions can lead to splenomegaly.

2) To evaluate for cirrhosis, you can first consider liver function tests and a liver ultrasound.  Findings from these tests may suggest cirrhosis.  To make a firm diagnosis, a liver biopsy would have to be performed.  If suspected, this can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com

[mediaworks]

Thank you for getting back to me.  

I have had both an ultrasound and ct scan - both came back clear as have 4 separate liver panels taken over the last few months.  However, after learning so much about cirrhosis and how the liver works I would just be shocked if I haven't already done serious harm - I know that sounds crazy, but is it possible to have cirrhosis and not have any "symptoms" other than a "slightly" enlarged spleen and somewhat low platelets and wbc.

I just find it odd that no doctor can really give me a clear answer as to why the slightly enlarged spleen and low platelets.

Thanks again